Acid exposure time is sensitive for detecting gastroesophageal reflux disease and is associated with long-term survival after lung transplant.

Gastroesophageal reflux disease (GERD) is common in patients who have undergone lung transplantation and is associated with poorer outcomes, but guidelines are lacking to direct management strategies in this population. We assessed the diagnostic yield of impedance metrics compared to pH-metry alone for detecting GERD among lung transplant recipients and evaluated their association with clinical outcomes. We performed a retrospective cohort study of consecutive patients who underwent lung transplantation. Demographic data, acid exposure time (AET), number of reflux episodes, mean nocturnal baseline impedance (MNBI), post-reflux swallowing-induced peristaltic wave index (PSPWI), and clinical outcomes including mortality were collected. The relationship between GERD metrics and clinical outcomes was assessed using Wilcoxon signed-rank test and Fisher's exact test as appropriate. Of the 76 patients studied, 29 (38%) had GERD based on abnormal AET after lung transplantation. One (1.3%) patient had GERD based on elevated number of reflux episodes and abnormal distal MNBI detected GERD in 19 (26%) patients, resulting in 62% sensitivity and 94% specificity. Two (2.6%) patients had normal PSPWI. Patients with low distal MNBI had significantly decreased forced expiratory volume in 1 second (FEV1) at 3-year posttransplant compared to those without low distal MNBI (P = 0.03). Three-year survival was significantly worse among patients with elevated AET (66.7% vs. 89.1%, P = 0.03) but not with low distal MNBI (68.4% vs. 84.3%, P = 0.18). Abnormal AET is more sensitive for detecting GERD than other reflux metrics studied and is associated with survival, suggesting pH-metry alone may be sufficient to guide GERD management after lung transplant.

Public and personal depression stigma in a rural American female sample.

We examined public and personal stigma among a community sample of 1,000 women living in primarily rural counties of Western Kentucky. Data on demographics, depression, stigma, health information sources, and availability of health services were collected via a random digit dial survey. The prevalence of depression was 15.7%. The majority of respondents (82.2%) reported congruent levels of stigma with 11.6% reporting high public and high personal stigma. However, 17.8% of respondents reported incongruent public and personal stigma. The 7.5% of women with low public and high personal stigma were older and less educated, preferred anonymous sources of health information, and reported better availability of health services. The 10.3% of women with high public and low personal stigma were younger and more educated, preferred interpersonal sources of health information, and reported poorer availability of health services. In multivariate analyses, depression and lower education were associated with any incongruent stigma, while rural residence and White race/ethnicity was associated with high personal and public stigma. Psychiatric nurses should develop community-based and targeted, point-of-care interventions to reduce public and personal stigma among rural women.

Course of tic disorders over the lifespan.

PURPOSE OF REVIEW: To summarize and update information on the course of tic disorders from childhood through later life. RECENT FINDINGS: Tics tend to improve substantially over the first year after they appear. However, contrary to widespread opinion, tics usually last longer than one year, though usually at minimal severity. Tics often wane to clinical insignificance over the teen years, possibly resurging occasionally over the lifespan. However, in an important minority of patients, tics remain clinically relevant throughout life. Tics rarely first come to clinical attention later in adulthood, but new reports describe additional such cases. SUMMARY: Recent publications have shown tics to persist past a few months more often than previously thought, though often at minimal severity, and recurrence after an asymptomatic period is common. The safety and efficacy of behavior therapy for tics, together with prospective indicators of early prognosis, make feasible the possibility of bettering the lifetime course of tic disorders with early intervention.

Perinatal western-type diet and associated gestational weight gain alter postpartum maternal mood.

INTRODUCTION: The role of perinatal diet in postpartum maternal mood disorders, including depression and anxiety, remains unclear. We investigated whether perinatal consumption of a Western-type diet (high in fat and branched-chain amino acids [BCAA]) and associated gestational weight gain (GWG) cause serotonin dysregulation in the central nervous system (CNS), resulting in postpartum depression and anxiety (PPD/A). METHODS: Mouse dams were fed one of four diets (high-fat/high BCAA, low-fat/high BCAA, high-fat, and low-fat) prior to mating and throughout gestation and lactation. Postpartum behavioral assessments were conducted, and plasma and brain tissues assayed. To evaluate potential clinical utility, we conducted preliminary human studies using data from an extant sample of 17 primiparous women with high GWG, comparing across self-reported postpartum mood symptoms using the Edinburgh Postnatal Depression Scale (EPDS) for percent GWG and plasma amino acid levels. RESULTS: Mouse dams fed the high-fat/high BCAA diet gained more weight per kcal consumed, and BCAA-supplemented dams lost weight more slowly postpartum. Dams on BCAA-supplemented diets exhibited increased PPD/A-like behavior, decreased dopaminergic function, and decreased plasma tyrosine and histidine levels when assessed on postnatal day (P)8. Preliminary human data showed that GWG accounted for 29% of the variance in EPDS scores. Histidine was also lower in women with higher EPDS scores. CONCLUSIONS: These findings highlight the role of perinatal diet and excess GWG in the development of postpartum mood disorders.

Template synthesis of nanophase mesocarbon.

Templating techniques are used increasingly to create carbon materials with precisely engineered pore systems. This article presents a new templating technique that achieves simultaneous control of pore structure and molecular (crystal) structure in a single synthesis step. With the use of discotic liquid crystalline precursors, unique carbon structures can be engineered by selecting the size and geometry of the confining spaces and selecting the template material to induce edge-on or face-on orientation of the discotic precursor. Here mesophase pitch is infiltrated by capillary forces into a nanoporous glass followed by slow carbonization and NaOH etching. The resulting porous carbon material exhibits interconnected solid grains about 100 nm in size, a monodisperse pore size of 60 nm, 42% total porosity, and an abundance of edge-plane inner surfaces that reflect the favored edge-on anchoring of the mesophase precursor on glass. This new carbon form is potentially interesting for a number of important applications in which uniform large pores, active-site-rich surfaces, and easy access to interlayer spaces in nanometric grains are advantageous.

Personalized health planning with integrative health coaching to reduce obesity risk among women gaining excess weight during pregnancy.

Health coaching is an emerging behavioral intervention to improve outcomes in chronic disease management and prevention; however, no studies have investigated its utility in postpartum women who have gained excess weight during pregnancy. A 32-year-old primigravida woman who was overweight at conception and gained 23 lbs more than Institute of Medicine recommendations for her pre-pregnancy body mass index participated in a 6-month personalized health planning with integrative health coaching (PHPIHC) intervention. The intervention included a baseline health risk assessment review with a healthcare provider and eight biweekly, 30-minute telephonic health coaching sessions. The participant demonstrated improvement in physical activity, energy expenditure, knowledge, and confidence to engage in healthpromoting behaviors. Although the participant did not reach the target weight by completion of the health coaching sessions, follow up 8 months later indicated she achieved the target goal (within 5% of prepregnancy weight). This case report suggests that PHP-IHC can support postpartum women in returning to pre-pregnancy weight after gaining excess gestational weight. Future research and clinical trials are needed to determine the best timing, length, and medium (online, in-person, telephonic) of PHP-IHC for postpartum women.

La formación de salud es una nueva intervención conductual para mejorar los resultados en la prevención y el tratamiento de la enfermedad crónica; sin embargo, ningún estudio ha examinado su utilidad en las mujeres puérperas que han aumentado excesivamente de peso durante el embarazo. Una mujer primigesta de 32 años de edad que presentaba sobrepeso en el momento de la concepción y había engordado 10,5 kg más que las recomendaciones establecidas por el Instituto de Medicina (IOM, por sus siglas en inglés) para su índice de masa corporal previo al embarazo participó en un plan sanitario de 6 meses de duración con una intervención de formación de salud integradora (PHP-IHC, por sus siglas en inglés). La intervención incluyó una revisión de evaluación basal del riesgo para la salud con un profesional sanitario y 8 sesiones telefónicas de formación de salud de 30 minutos de duración cada quince días. La participante demostró mejorías en la actividad física, el consumo de energía, el conocimiento y en la confianza a la hora de implicarse en comportamientos que favorecían su salud. A pesar de que la participante no logró alcanzar el peso objetivo al finalizar las sesiones de formación de salud, una visita de seguimiento 8 meses después confirmó que lo había alcanzado (dentro del 5 % del peso previo al embarazo). Este caso clínico sugiere que el PHP-IHC puede ayudar a las mujeres puérperas a recuperar el peso previo al embarazo tras el aumento de peso excesivo durante la gestación. Se necesitan investigaciones y ensayos clínicos futuros para determinar el momento, la duración y el método (en línea, en persona o telefónico) idóneos del PHP-IHC para la mujeres puérperas.